| NPI | 1376552489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI DJ066423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME113785) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2018-12-12 |